The Utility of 24-h Video-EEG Monitoring in the Diagnosis of Epilepsy in Children

Objectives: Evaluate the diagnostic yield of 24-h video-EEG monitoring in a group of children admitted in our epilepsy monitoring unit (EMU). Methods: 232 children who underwent 24-h video-EEG monitoring was analysed. We divided each patient's monitoring duration into the first 1, 2, 4, 8, 16 h, relative to the whole 24 h monitoring period. The detection of the first interictal epileptiform discharges (IEDs), epileptic seizures (ES), and psychogenic non-epileptic seizures (PNES) were analysed relative to the different monitoring time subdivision. Results: Our findings revealed that: (1) there was no significant difference in the prevalence of detecting initial IEDs between the first 4-h and 24-h monitoring periods (73.7% vs 81%); (2) clinical events detection rate was statistically similar between the first 8-h and 24-h monitoring periods (15.5% vs 19.3%); (4) an 8-h monitoring was sufficient to capture IEDs, ES and PNES in focal epilepsy children; (5) a 1-h monitoring was sufficient to capture IEDs, ES and PNES in generalized epilepsy children; and (6) IEDs were detected within the first 1-h of monitoring in 96.7% self-limited focal epilepsies (SeLFEs) patient. Conclusion: Our study suggests that a 4-h monitoring has more value in increasing the detection rate of IEDs compared to the traditional shorter routine EEG. And in the case of SeLFEs, a 1-h of monitoring might be sufficient in detecting IEDs. A 24-h VEEG monitoring can detect clinical events in 19.3% of patients. Overall, the yield of IEDs and clinical events detection is adequate in children in children undergoing 24-h video-EEG monitoring.